Mobile crisis response

Goals and overview: someone to respond

A behavioral health crisis can be devastating, and even traumatic, for individuals, families, and communities. Although we cannot know when a crisis may occur, we can create a system that is agile and responsive when the need arises. We imagine a crisis system in Washington state that minimizes delays, reduces the use of law enforcement and emergency departments, and only looks to the most restrictive responses when no other safe resolution exists.

A key component of our state’s crisis system must include mobile crisis response (MCR) teams that can be rapidly deployed to the location of the crisis and provide crisis assessment and stabilization services to anyone, anywhere, and at any time.

Program guide

The Mobile Crisis Response program guide was developed using SAMHSA’s best practice toolkit. The guide was created to standardize mobile crisis response programs while still giving regions the ability to make teams work for their unique areas and serves as the first step in standardizing mobile crisis response in the state. It serves as a clinical and operational guide for new and existing teams. Best practices direct teams to improving services and moving practices toward implementing SAMHSA’s best practices in Washington’s crisis system enhancements.

View the program guide.

Mobile crisis teams: future work and expansion

HCA is working to expand the crisis system to respond to an increase in calls to 988 in alignment with SAMSHA's best practices for crisis response. SAMHSA’s vision for comprehensive crisis care that is for anyone, anytime, anywhere and comprised of three key components; someone to contact, someone to respond, and somewhere to go.

HCA continues to work with Behavioral health administrative service organizations (BH-ASOs), managed care organizations (MCOs), the Crisis Response Improvement (CRIS) committee and subcommittees, providers and stakeholders on the crisis system expansion to ensure adequate coverage for an equitable response statewide as calls to 988 increase. Building mobile crisis response teams to capacity in alignment with SAMHSA’s vision will reduce response times, reduce the likelihood of unnecessary contact with law enforcement or continued reliance on emergency responders like fire and EMS for behavioral health needs.

Adult mobile crisis response

Mobile crisis response (MCR) services offer voluntary community-based interventions to individuals in need wherever they are including at home, work, school, courts, or anywhere else in the community where the person is experiencing a crisis. The caller, not the provider, defines the crisis. These services are provided by two-person teams that include a behavioral health clinician and a certified peer counselor.

Key components of quality MCR services include:

• Triage/screening, including explicit screening for suicidality and risk of harm to others
• Responding without law enforcement accompaniment, unless special circumstances warrant inclusion, to support true justice system diversion
• Reducing the use of emergency departments
• Assessing for risk and opportunities to resolve the crisis in the least restrictive setting
• Developmentally appropriate de-escalation/resolution
• Peer support; including family peers or youth peers
• Coordination with medical and behavioral health services
• Crisis planning and follow up

Mobile response and stabilization services (MRSS) for youth and families

MRSS is a child and family specific intervention that recognizes the unique developmental needs of youth. Caregivers and youth are interconnected so when a youth is in crisis, the caregiver’s ability to respond to the crisis can be impacted. Supporting the caregiver’s response to the behavioral health need decreases the likelihood of calling 911, juvenile justice or child welfare involvement.

MRSS removes the word crisis, because in this comprehensive crisis continuum, youth can be screened during a crisis event and stabilized and connected to resources and supports after stabilization. This reduces barriers to ongoing clinical care, prevents return to the crisis phase, and improves outcomes.

In addition to the goals for all MCR services, MRSS is unique in the following areas:

• There is an initial response for 72 hours, and a separate stabilization phase for up to 14 days
• The crisis is defined by the youth, young adult, parent, or caregiver
• The team responds in person with peers within two hours and without law enforcement
• The team works with the youth and caregivers to reduce admissions to emergency departments (EDs) or adolescent inpatient units, and prevent unnecessary contact with law enforcement or child welfare
• Support and maintain youth in their living and community environment, reducing out of home placements
• Promote and support safe behavior in the home, schools, and community
• Ensure staff are trained in culturally responsive, developmentally appropriate trauma-informed care, de-escalation, safety planning for youth and families, and harm reduction
• Assist youth and families in identifying, accessing, and linking to natural and clinical supports
• Teams should provide robust outreach and engagement with youth system of care partners

HCA's crisis systems team (CST) is working to expand dedicated youth teams statewide and implement MRSS expansion through the ongoing work of HB 1477 and the CRIS committees.

Mobile crisis response endorsement program

The goal of the Mobile crisis response endorsement program is to enhance the statewide behavioral health crisis response system and ensure individuals experiencing a crisis have access to help easily in their regions. Endorsed teams meet standards for staffing, training, and transportation ensuring they maintain the capacity to respond quickly and effectively to the most acute calls received by 988 Suicide & Crisis Lifeline.

Learn more about the mobile crisis response endorsement program.